IRISC

International Research Institute into Spirituality and Change

by the Revd Dr Ian Carter, Chaplain, the Royal Oldham Hospital

Since it started in 1948, the NHS has recognised the need for care of people’s spiritual needs as well as for physical, emotional and psychological components of their health. Body, mind and spirit are all part of what makes a person "tick". All need to be attended to in holistic care.

Before coming to work in a general hospital as chaplain, I worked part-time in a hospice in Wigan. Holistic care has been most readily embraced in hospice and palliative care settings. Perhaps it is where physical cure is recognised to be unobtainable that emotional and spiritual support gets the greater prominence. However, palliative medicine is underpinned by secular scientific discourses about death, and the insights of positivistic humanistic philosophy. Within this field spirituality is used as a term with a great plasticity of meaning, It is a relativised and fragmented concept, useful to many disciplines in different ways, which does not have a standard definition. Spirituality is used in ways which relate to an eclectic range of ideas and philosophies to do with beliefs, actions, values, meaning, purpose, fulfilment and hope. In most cases spirituality integrates and allows us to interpret the experience of life.

Despite the complexity and diversity within every religious tradition, such a description of spirituality would be seen by many within those traditions as strange and irreligious, neglecting some of the deepest insights of spiritual thinkers, who have often helped their various traditions to come to quite divergent views about what constitutes the heart of spirituality.

Returning to my starting point of patient care, polls and censuses suggest that relatively few within the population belong actively to a faith community or regularly attend religious services. Yet an overwhelming majority of our patients agree to being recorded as belonging to a religious tradition. There is a least nominal membership of a religious tradition in the patient population of our hospitals (if CoE can be described as religious!) and Christian nominalism, rather than the secularism the media would have us believe, is the recorded prevalent belief of our community. Those recorded as no religion are a tiny minority. However suggestions of any overtly sacramental ministry with the majority of our patients can be rejected as foreign to their understanding of religion, although they usually appreciate pastoral care, counselling and often prayer.

Practically spirituality can be expressed in many different ways, particularly smell and touch in aromotherapy, but also imagery, music, art, poetry, storytelling, exercise and relaxation as well as the more overtly religious prayer, meditation or ritual. For some meaning comes through the more mundane aspects of life work, money, possessions, social relationships, and a spell isolated from these things can be debilitating. In many respects in our post-modern society spiritual ideals and aspirations are regarded as a matter of personal or private choice. They may or may not include an understanding of transcendence, which is key to the majority of religions. Any practice from Acupuncture to Zen may be embraced by individuals with little or no regard to their basis in religious belief. Some combinations of therapies may seem quite bizarre and irrational to theological reflection, a twisted flight from holism to ritual and magic.

An awareness of this broad ‘spiritual’ dimension for everyone helps us to realise that it is not just those who have explicitly stated religious needs who may need support. Indeed, I have been able to help some of those in the ‘No Religion’ category who have felt a spiritual need at a time of crisis. They may be helped by discovering what brings quality to their life, what external resources they have in relationships and sources of strength, what internal resources or vulnerabilities they have.

At a workshop for palliative care professionals recently, I asked a multidisciplinary team of some 20 people to complete a questionnaire. Over 90% agreed strongly with statements that patients needed someone to listen to them, to ‘be there’ to support them, and to provide information for them. The most important issues to patients (the most important first) were seen as:- pain, concern for relatives, suffering, death and dying, why me? and the least important (continuing a descending order):- the meaning of life, forgiveness, afterlife, nature of God. I also asked perceptions of patients’ need for spiritual care, these were ordered (most important first):- counselling, conscious dying, forgiveness, music, stillness, prayer and the least important:- worship, religious books, alternative therapy, meditation, confession, anointing, baptism.

I asked the same group about the things that most upset them in conversation with a patient. They were:- feelings of inadequacy (75%), suicidal thoughts (65%), communication problems (55%), anger (50%), cost effective services (50%), suspension of treatment (40%), silence (35%), major disaster (30%), while life choices rated only 15% and religion was at the same mere 5% as mental well being.

I have found one of the most useful approaches in work with patients is that of advocacy - of giving help and support to people to pursue their own needs when for example their families, ourselves, colleagues or other professionals may have ambivalent feelings about those expressed needs. I think it important to recognise that our views / ritual / answers / lack of answers are not the patients and should not be projected on them. It would seem from data such as the above that the concerns of chaplains as representatives of the faith communities may well not be the concerns of the patients and health care professionals, so an approach like advocacy can root us in what is actually needed in the situation.

But is this an irrational approach? A chaplain like myself comes from a specific tradition, embedded in a social and doctrinal context. They have often been led to ministry by the exercise of a lively faith within a community of belief. To attempt to abstract spiritual care from this seems an artificial endeavour. Of course there may be those who in today’s post-modern context argue that pluralism dictates that we reject the notion that there is only one true reality to belief. and suggest that we need to move away from false certainties, rejecting epistemological foundationalism as well as relativising the conflicting metanarratives of the various religions. I think that in its extreemist form this approach can undervalue and undermine the whole enterprise of spiritual help in the health care setting.

Despite the interpreted and hermeneutical dimension of religious belief, to assert that each group and every context can have its own internal rationality, as some post-modernists might, would leave us with an extreme relativism that is devastating to the spiritual integrity of both chaplains and patients alike. One possible way forward might be by a post-foundational approach (e.g. of Wentzel van Huyssteen Duet or Duel? Theology and Science in a Postmodern World SCM Press, 1998) As we proceed rationally in an attempt to discover truth, we internalise those beliefs that are acceptable in terms of our own judgement as the best current estimate of the truth. As such, what we believe is not an approximation to truth of religious claims, but an estimation of truth, from within a particular cultural, linguistic, social and historical religious context.

Those who share this notion can work together with integrity and humility, constrained not by arguments about the evidence for faith positions, but set free by a common commitment to the purpose of our pastoral work within the health care setting. A broader and richer notion of the nature of belief is revealed, with a distinct pragmatic dimension. This does not mean that there are no challenging issues of interpreted experience to be dealt with, but it does mean that we can respect each others and our own integrity in meeting pluralist spiritual needs.

 

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